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  5. Timing of Loading

Timing of Loading

Implant loading protocols are categorised into three types: immediate loading (within 1 week of implant placement), early loading (between 1 week and 2 months), and conventional loading (after 2 months) (Morton and Pollini, 2017).

Advantages of Immediate Loading:

  • Provides immediate restoration of function, phonetics, and aesthetics.
  • Reduces overall treatment time and the number of clinical visits.
  • Minimises postoperative discomfort.
  • Enhances patient satisfaction and quality of life.
  • Can achieve successful osseointegration under normal functional occlusal loads.

For early or immediate loading, good bone quality, adequate bone quantity, and implant primary stability are essential. An implant stability quotient (ISQ) value of at least 60 is recommended for immediate loading. In multi-unit situations, immediately loaded implants should be rigidly splinted using superstructures.

Conventional (Delayed) Loading is recommended in the following cases:

  • Poor implant primary stability.
  • Substantial bone augmentation required.
  • Implants with reduced dimensions.
  • Compromised host conditions such as bruxism or parafunctional habits.

Systematic reviews indicate that the clinical outcomes and survival rates for immediately and early loaded implants are generally comparable to those of conventionally loaded implants (Esposito et al., 2013; Zhang et al., 2017). However, some reviews report slightly higher failure rates for immediately loaded implants compared to conventionally loaded implants, although survival rates remain high for both (Chrcanovic et al., 2015c; Sanz-Sanchez et al., 2015). These findings should be interpreted with caution due to potential biases in the studies included in these reviews.